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Protocol for the Examination of Specimens From Patients With Uveal Melanoma.



A Basis for Checklists

This protocol is intended to assist pathologists in providing clinically useful and relevant information as a result of the examination of surgical specimens. Use of this protocol is intended to be entirely voluntary. If equally valid protocols or similar documents are applicable, the pathologist is, of course, free to follow those authorities. Indeed, the ultimate judgment regarding the propriety pro·pri·e·ty  
n. pl. pro·pri·e·ties
1. The quality of being proper; appropriateness.

2. Conformity to prevailing customs and usages.

3. proprieties The usages and customs of polite society.
 of any specific procedure must be made by the physician in light of the individual circumstances presented by a specific patient or specimen.

It should be understood that adherence to this protocol will not guarantee a successful result. Nevertheless, pathologists are urged to familiarize themselves with the document. Should a physician choose to deviate from the protocol based on the circumstances of a particular patient or specimen, the physician is advised to make a contemporaneous con·tem·po·ra·ne·ous  
adj.
Originating, existing, or happening during the same period of time: the contemporaneous reigns of two monarchs. See Synonyms at contemporary.
 written notation of the reason for the procedure followed.

The College recognizes that this document may be used by hospitals, attorneys, managed care organizations, insurance carriers, and other payers. However, the document was developed solely as a tool to assist pathologists in the diagnostic process by providing information that reflects the state of relevant medical knowledge at the time the protocol was first published. It was not developed for credentialing, litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.

When a person begins a civil lawsuit, the person enters into a process called litigation.
, or reimbursement Reimbursement

Payment made to someone for out-of-pocket expenses has incurred.
 purposes. The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document.

PROTOCOL FOR THE EXAMINATION OF SPECIMENS FROM PATIENTS WITH UVEAL MELANOMA Uveal Melanoma is cancer (melanoma) of the eye involving the iris, ciliary body, or choroid (collectively referred to as the uvea) with advanced tumors encompassing more than one of these structures. Tumors arise from the pigment cells (melanocytes) that give color to the eye.  
I. Cytologic Material
   A. Clinical information
      1. Patient identification
         a. Name
         b. Identification number
         c. Age (birth date)
         d. Gender
      2. Responsible physician(s)
      3. Date of procedure
      4. Other clinical information
         a. Relevant history
            (1) Clinical findings
            (2) Past ocular history
            (3) Previous ocular surgery
            (4) Previous treatment
         b. Relevant findings (eg, liver function tests,
            ultrasound)
         c. Clinical diagnosis
         d. Procedure (eg, fine-needle aspiration, anterior
            chamber paracentesis)
         e. Operative findings
         f. Anatomic site (right or left eye; part of eye
            sampled)
   B. Macroscopic examination
      1. Specimen
         a. Unfixed/fixed (specify fixative)
         b. Number of slides received
         c. Quantity and appearance of fluid specimen
         d. Other (eg, core of tissue in needle shaft)
         e. Intraoperative/intraprocedural consultation
      2. Material submitted for microscopic evaluation
         (eg, cytocentrifuge, smear, filter preparation)
      3. Material submitted for special studies (specify)
         (eg, immunocytochemistry)
   C. Microscopic evaluation
      1. Adequacy of specimen for evaluation (if unsatisfactory
         for evaluation, specify reason)
      2. Tumor, if present
         a. Histologic type, if possible (note A)
         b. Other characteristics (note B)
            (1) Presence of pigment
            (2) Cytoplasmic indentation of nucleus
            (3) Cytoplasmic vacuolization
      3. Additional pathologic findings, if present (eg,
         presence of retinal tissue, inflammatory cells)
      4. Results/status of special studies (specify)
      5. Comments
         a. Correlation with intraprocedural consultation
         b. Correlation with other specimens, as appropriate
         c. Correlation with clinical information, as
            appropriate
II. Biopsy
    A. Clinical information
       1. Patient identification
          a. Name
          b. Identification number
          c. Age (birth date)
          d. Gender
       2. Responsible physician(s)
       3. Date of procedure
       4. Other clinical information
          a. Relevant history
             (1) Clinical findings
             (2) Past ocular history
             (3) Previous ocular surgery
             (4) Previous treatment
          b. Relevant findings (eg, liver function tests,
             ultrasound)
          c. Procedure (eg, peripheral iridectomy, iridocyclectomy,
             sclerouveectomy)
          d. Operative findings
          e. Anatomic site of specimen (right or left
             eye)
    B. Macroscopic examination
       1. Specimen
          a. Unfixed/fixed (specify fixative)
          b. Orientation (if indicated by surgeon by
             written instruction, diagram, or suture);
             ink margins of excisional biopsy specimens
          c. Previously opened
          d. Number of pieces
          e. Size(s) (3 dimensions, if possible)
          f. Tumor
             (1) Size (3 dimensions, if possible)
             (2) Presence of necrotic tissue
             (3) Descriptive features
          g. Other tissues, as appropriate
          h. Results of intraoperative consultation
       2. Tissue submitted for microscopic evaluation
          (specify)
       3. Special studies (specify) (eg, special histochemical
          stains, immunohistochemical stains)
    C. Microscopic evaluation
       1. Tumor
          a. Histologic type (note A)
          b. Histologic grade
          c. Extent
             (1) Involvement of adjacent structures,
                 such as ciliary body
             (2) Extraocular extension
             (3) Invasion of normal vessels or tumor
                 vessels
          d. Other prognostic features (note B)
       2. Additional pathologic findings, if present
          a. Drusen
          b. Neovascularization
          c. Nevus
          d. Ectropion uveae
          e. Other(s)
       3. Results/status of special studies (specify)
       4. Comments
          a. Correlation with intraoperative consultation
          b. Correlation with other specimens, as appropriate
          c. Correlation with clinical information, as
             appropriate
III. Resection Specimen (Globe)
     A. Clinical information
        1. Patient identification
           a. Name
           b. Identification number
           c. Age (birth date)
           d. Gender
        2. Responsible physician(s)
        3. Date of procedure
        4. Other clinical information
           a. Relevant history
              (1) Clinical findings
              (2) Past ocular history
              (3) Previous ocular surgery
              (4) Previous treatment
           b. Relevant findings (eg, liver function tests,
             ultrasound)
           c. Clinical diagnosis
           d. Procedure (usually enucleation)
           e. Operative findings
           f. Anatomic site of specimen (right or left
              eye)
        5. Documentation of areas marked by surgeon
           for orientation (eg, suture, diagram)
     B. Macroscopic examination
        1. Specimen
           a. Organ(s)/tissue(s) included
           b. Unfixed/fixed (specify fixative) (note C)
           c. Orientation (note D)
           d. Description of other tissues, as appropriate
           e. Results of intraoperative consultation
        2. Globe
           a. Evidence of previous excision or treatment
           b. Note if previously opened/sectioned and
              in what fashion (note E)
           c. Size
              (1) Anteroposterior, horizontal, vertical dimensions
                  of globe
              (2) Length and diameter of attached optic
                  nerve
              (3) Corneal horizontal and vertical diameter
              (4) Diameter of pupil, if visible
           d. Transillumination (helpful to identify location
              of tumor and measure basal dimension
              prior to sectioning globe)
              (1) Quality of transillumination (eg, poor
                  light transillumination, transilluminates
                  light well)
              (2) Transillumination defect
                    i. Location
                   ii. Relationship to equator of globe
                  iii. Relationship to limbus
                   iv. Clock hour(s) of iris/globe
                    v. Size (2 dimensions)
           e. Mark outline with marking implement
           f. Extrascleral extension, if present
           g. Sectioning of specimen (globe) (note E)
           h. Mass/tumor, if present
              (1) Location
              (2) Size (notes F and G)
                   i. Base at cut edge (ie, portion of tumor
                      closest to sclera)
                  ii. Height at cut edge
              (3) Distance of anterior margin of tumor
                  base from limbus at cut edge
              (4) Distance of posterior margin of tumor
                  base from edge of optic disc
              (5) Other descriptive features (color, consistency,
                  shape)
              (6) Structures involved and extent (note G)
                    i. Retinal involvement
                   ii. Optic nerve involvement
                  iii. Macroscopic involvement of vitreous
                   iv. Involvement of ciliary body
                    v. Macroscopic involvement of anterior
                       chamber angle
           i. Features of other (uninvolved) ocular tissues
              (1) Cornea (eg, clear, cloudy, opaque)
              (2) Anterior chamber (eg, deep, shallow,
                  flat)
              (3) Angle (eg, open, narrow, closed)
              (4) Iris (eg, color, any abnormalities)
              (5) Ciliary body
              (6) Lens (eg, clear, cataractous, presence of
                  lens implant, absence)
              (7) Vitreous (eg, color, consistency, hemorrhage)
              (8) Retina (eg, detachment, total or partial;
                  hemorrhages)
              (9) Choroid
              (10) Sclera (eg, thinning, defects)
              (11) Optic disc (eg, pallor, increased cup/
                   disc ratio)
        3. Tissues submitted for microscopic examination
           (specify) (note E)
        4. Special studies (specify) (eg, immunohistochemistry)
     C. Microscopic evaluation
        1. Tumor
           a. Site (choroid, ciliary body, iris) (note G)
           b. Histologic type (note A)
           c. Histologic grade
           d. Extent of invasion (note G)
           e. Size (note F)
           f. Anatomic extent (notes B and G)
              (1) Anterior margin of tumor
              (2) Retinal or scleral involvement
              (3) Angle involvement
              (4) Vitreal involvement
              (5) Optic nerve involvement
        2. Margins
           a. Extrascleral extension (notes B and G)
           b. Surgical margin of optic nerve (note B)
        3. Other prognostic features (note B)
        4. Additional pathologic findings, if present
           a. Cancer-related
              (1) Cataract
              (2) Vitreous hemorrhage
              (3) Glaucomatous optic atrophy
              (4) Secondary angle closure
              (5) Secondary open-angle glaucoma
              (6) Iris neovascularization
              (7) Retinal atrophy
           b. Other
              (1) Corneal disease
              (2) Diabetic retinopathy
        5. Results/status of special studies (specify)
        6. Comments
           a. Correlation with intraoperative consultation
           b. Correlation with other specimens, as appropriate
           c. Correlation with clinical information, as
              appropriate


EXPLANATORY NOTES

A: Histologic his·tol·o·gy  
n. pl. his·tol·o·gies
1. The anatomical study of the microscopic structure of animal and plant tissues.

2. The microscopic structure of tissue.
 Type.--The modified Callender classification shown below is used for determining cell type, but has prognostic prog·nos·tic
adj.
1. Of, relating to, or useful in prognosis.

2. Of or relating to prediction; predictive.

n.
1. A sign or symptom indicating the future course of a disease.

2.
 significance only for tumors of the choroid and ciliary body ciliary body
n.
A thickened portion of the vascular tunic of the eye located between the choroid and the iris.


Ciliary body
A structure in the eye that contains muscles that will affect the focusing of the lens.
, not those of the iris, which generally have a benign course.[1-4]
Spindle cell nevus: slender cells with fusiform nuclei, delicate
    nuclear chromatin, and inapparent nucleoli; no
    mitoses are found
Spindle cell melanoma(*)
  Spindle A: slender cells with a thin oval nucleus, indistinct
    nucleoli, and often a longitudinal fold in the nuclear
    membrane
  Spindle B: larger plumper nuclei with sharply defined,
    round nucleoli
Mixed cell melanoma: both spindle and epithelioid cells
    present
Epithelioid cell melanoma(*): larger, more pleomorphic, polygonal
    cells with large, sometimes multiple nucleoli

 (*) Spindle cell melanomas have the most favorable prognosis
and epithelioid cell melanomas the least favorable in
terms of survival.


B: Other Pathologic pathologic /patho·log·ic/ (path?ah-loj´ik)
1. indicative of or caused by some morbid condition.

2. pertaining to pathology.
 Features of Prognostic Significance.--Other histologic features with prognostic significance in choroidal cho·roi·dal
adj.
Of or relating to the choroid.



choroidal

pertaining to or emanating from the choroid.


choroidal hypoplasia
 and ciliary body melanoma Ciliary Body Melanoma is a type of cancer arising from the coloured part (uvea) of the eye.

About 12% of uveal melanoma arise from the ciliary body.

Clinical features

It occurs most commonly in the sixth decade.
 include the number of mitoses in 40 high-power fields, pigmentation pigmentation, name for the coloring matter found in certain plant and animal cells and for the color produced thereby. Pigmentation occurs in nearly all living organisms. , degree of inflammation, growth pattern (diffuse choroidal melanomas and ring melanomas of the ciliary body have a much less favorable prognosis), location of anterior anterior /an·te·ri·or/ (an-ter´e-or) situated at or directed toward the front; opposite of posterior.

an·te·ri·or
adj.
1. Placed before or in front.

2.
 margin of tumor tumor: see neoplasm. , degree and patterns of vascularity, blood vessel blood vessel
n.
An elastic tubular channel, such as an artery, a vein, a sinus, or a capillary, through which the blood circulates.


blood vessel(s),
n the network of muscular tubes that carry blood.
 invasion (both tumor vessels and normal vessels), tumor necrosis tumor necrosis Death of tumor tissue, a common event in aggressive CAs in which the tumor rapidly outgrows its blood supply, resulting in tumor cell death. Cf Apoptosis. , extraocular extension, and optic nerve optic nerve: see vision.  involvement.[4-15]

C: Fixative fixative /fix·a·tive/ (fik´sit-iv) an agent used in preserving a histological or pathological specimen so as to maintain the normal structure of its constituent elements.

fix·a·tive
adj.
.--The minimum recommended fixation fixation: see psychoanalysis.  time for whole globes with intraocular intraocular /in·tra·oc·u·lar/ (-ok´u-lar) within the eye.

in·tra·oc·u·lar
adj.
Within the eyeball.


Intraocular
Literally, within the eye.
 tumors is 48 hours. The globe should be fixed in an adequate volume of fixative with at least a 10:1 ratio of fixative volume to specimen volume recommended. Incisions or windows in the globe are not necessary for adequate penetration of fixative and are not recommended. Injection of fixative into the globe is also not recommended (due to the possibility of introducing artifact A distortion in an image or sound caused by a limitation or malfunction in the hardware or software. Artifacts may or may not be easily detectable. Under intense inspection, one might find artifacts all the time, but a few pixels out of balance or a few milliseconds of abnormal sound ).

D: Orientation.--The orientation of a globe may be determined by identification of extraocular muscle ex·tra·oc·u·lar muscle
n.
Any of the six small muscles that control movement of the eyeball within the socket.
 insertions, the optic nerve, and other landmarks, as illustrated in Figure 1. The terms temporal and nasal are generally used in place of lateral and medial medial /me·di·al/ (me´de-il)
1. situated toward the median plane or midline of the body or a structure.

2. pertaining to the middle layer of structures.


me·di·al
adj.
 with reference to ocular ocular /oc·u·lar/ (ok´u-lar)
1. of, pertaining to, or affecting the eye.

2. eyepiece.


oc·u·lar
adj.
1. Of or relating to the eye or the sense of sight.
 anatomy.

[ILLUSTRATION OMITTED]

E: Sectioning the Globe.--The globe is generally sectioned in the horizontal or vertical plane with care to include the pupil and optic nerve along with tumor/mass in the section to be submitted for microscopic examination. If the mass cannot be included with horizontal or vertical sectioning, the globe is sectioned obliquely o·blique  
adj.
1.
a. Having a slanting or sloping direction, course, or position; inclined.

b. Mathematics Designating geometric lines or planes that are neither parallel nor perpendicular.

2.
 to include the tumor, pupil, and optic nerve, as illustrated in Figure 2. Alternative methods of sectioning have been described.[16]

F: Tumor Size.--Tumor size has prognostic significance. Many studies of choroidal and ciliary body melanoma have defined small tumors as being less than 10 mm in greatest diameter.[4] More recently, an ongoing study started in 1986, the Collaborative Ocular Melanoma Ocular melanoma
A malignant tumor that arises within the structures of the eye. It is the most common eye tumor in adults.

Mentioned in: Eye Cancer

ocular melanoma 
 Study,[17,18] defined the following size classification based on clinical measurements.
Small tumors(*):   smaller than medium or large tumors
                   defined below

Medium tumors:     [is greater than] 2.5 mm and
                   [is less than] 10 mm in height, and
                   [is less than] 16 mm in basal diameter

Large tumors:      [is greater than] 10 mm in height or
                   [is greater than] 2 mm in height and
                   [is greater than] 16 mm in basal diameter or
                   [is greater than] 8 mm in height with optic nerve
                   involvement

(*) Small tumors have a more favorable prognosis.[6,7]


G: TNM TNM tumor-nodes-metastasis; see under staging.

TNM

tumor, nodes and metastases; a system of cancer staging (see TNM staging).
 Stage Groupings.--The American Joint Committee on Cancer The American Joint Committee on Cancer (AJCC) is an organization best known for defining and popularizing cancer staging standards. External links
  • Official page
  • UCSF
  • Cancer.gov
 (AJCC AJCC American Joint Committee on Cancer )/International Union Against Cancer (UICC UICC Union International Contre le Cancer International Union against Cancer ) TNM staging systems TNM staging system,
n.pr stands for tumor
node
metastasis, a recognized method used to identify and predict the course of disease of a patient diagnosed with cancer.
 for uveal melanoma of the iris, ciliary body, and choroid are shown below.[19]

IRIS

Tumor (T)
TX   Primary tumor cannot be assessed
T0   No evidence of primary tumor
T1   Tumor limited to the iris
T2   Tumor involves 1 quadrant or less, with invasion
     into the anterior chamber angle
T3   Tumor involves more than 1 quadrant, with
     invasion into the anterior chamber angle, ciliary
     body, and/or choroid
T4   Tumor with extraocular invasion


Regional Lymph Nodes Lymph nodes
Small, bean-shaped masses of tissue scattered along the lymphatic system that act as filters and immune monitors, removing fluids, bacteria, or cancer cells that travel through the lymph system.
 (N)
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1   Regional lymph node metastasis


Distant Metastasis metastasis /me·tas·ta·sis/ (me-tas´tah-sis) pl. metas´tases  
1. transfer of disease from one organ or part of the body to another not directly connected with it, due either to transfer of pathogenic microorganisms or to
 (M)
MX   Presence of distant metastasis cannot be assessed
M0   No distant metastasis
M1   Distant metastasis


CILIARY BODY

Tumor (T)
TX      Primary tumor cannot be assessed
T0      No evidence of primary tumor
T1(*)   Tumor limited to the ciliary body
T2      Tumor invades into the anterior chamber and/
        or iris
T3      Tumor invades choroid
T4      Tumor with extraocular invasion


Regional Lymph Nodes (N)
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1   Regional lymph node metastasis


Distant Metastasis (M)
MX   Presence of distant metastasis cannot be assessed
M0   No distant metastasis
M1   Distant metastasis


CHOROID

Tumor (T)
TX      Primary tumor cannot be assessed
T0      No evidence of primary tumor
TI(*)   Tumor [is less than or equal to] 10 mm
        in greatest dimension with an
        elevation of [is less than or equal to] 3 mm
  T1a   Tumor [is less than or equal to] 7 mm in
        greatest dimension with an elevation of
        [is less than or equal to] 2 mm
  T1b   Tumor [is greater than] 7 mm but
        [is less than or equal to] 10 mm in
        greatest dimension with an elevation of
        [is greater than] 2 mm but
        [is less than or equal to] 3 mm
T2(*)   Tumor [is greater than] 10 mm but
        [is less than or equal to] 15 mm
        in greatest dimension with an elevation
        [is greater than] 3 mm but
        [is less than or equal to] 5 mm
T3(*)   Tumor [is greater than] 15 mm in greatest
        dimension or with an elevation
        [is greater than] 5 mm
T4      Tumor with extraocular invasion

(*) In clinical practice, the tumor base may be estimated
in optic disc diameters (dd) (average: 1 dd = 1.5 mm).
The elevation may be estimated in diopters (average 3 diopters
= 1 mm). Other techniques used, such as ultrasonography
and computerized stereometry, may provide a
more accurate measurement.

Note.--When dimension and elevation show a difference
in classification, the highest category should be used
for classification.


Regional Lymph Nodes (N)
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1   Regional lymph node metastasis


Distant Metastasis (M)
MX   Presence of distant metastasis cannot be assessed
M0   No distant metastasis
M1   Distant metastasis


TNM Stage Groupings for Uveal Melanoma of the Iris or Ciliary Body
Stage I     T1      N0      M0
Stage II    T2      N0      M0
Stage III   T3      N0      M0
Stage IVA   T4      N0      M0
Stage IVB   Any T   N1      M0
            Any T   Any N   M1


TNM Stage Groupings for Uveal Melanoma of the Choroid
Stage IA    T1a     N0      M0
Stage IB    T1b     N0      M0
Stage II    T2      N0      M0
Stage III   T3      N0      M0
Stage IVA   T4      N0      M0
Stage IVB   Any T   N1      M0
            Any T   Any N   M1


It should be noted that regional lymph node lymph node

Small, rounded mass of lymphoid tissue contained in connective tissue. They occur all along lymphatic vessels, with clusters in certain areas (e.g., neck, groin, armpits).
 involvement is rare in uveal melanoma. Metastasis to the liver and direct extension into the orbit are more common.[19]

References

[1.] Callender GR. Malignant melanotic melanotic /mel·a·not·ic/ (mel?ah-not´ik)
1. pertaining to or characterized by the presence of melanin.

2. characterized by melanosis.
 tumors of the eye: a study of histologic types in 111 cases. Trans Am Acad Ophthalmol Otolaryngol. 1931;36:131-142.

[2.] McLean IW, Zimmerman LE, Evans RM. Reappraisal of Callender's spindle spindle: see spinning.


A rotating shaft in a disk drive. In a fixed disk, the platters are attached to the spindle. In a removable disk, the spindle remains in the drive. Laptops use spindle designations to indicate the number of built-in drives.
 A type of malignant melanoma Malignant Melanoma Definition

Malignant melanoma is a type of cancer arising from the melanocyte cells of the skin. Melanocytes are cells in the skin that produce a pigment called melanin.
 of choroid and ciliary body. Am J Ophthalmol. 1978;86:557-564.

[3.] McLean IW, Foster WD, Zimmerman LE. Modifications of Callender's classification of uveal melanoma at the Armed Forces Institute of Pathology Armed Forces Institute of Pathology A section of the US military which provides consultations, reference atlases and educational programs for pathologists . Am J Ophthalmol. 1983;96:502-509.

[4.] Zimmerman LE. Malignant melanoma of the uveal tract Uveal tract
The pigmented membrane that lines the back of the retina of the eye and extends forward to include the iris. The uveal tract is sometimes called the uvea and has three parts: the iris, the choroid, and the ciliary body.

Mentioned in: Uveitis
. In: Spencer WH, ed. Ophthalmic Pathology Ophthalmic pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the eyes. Ophthalmic pathologists generally work closely with ophthalmologists. : An Atlas and Textbook. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1986:2072-2139.

[5.] Font RL, Spaulding AG, Zimmerman LE. Diffuse malignant melanoma of the uveal tract: a clinicopathologic report of 54 cases. Trans Am Acad Ophthalmol Otolaryngol. 1968;72:877-894.

[6.] McLean IW, Foster WD, Zimmerman LE. Prognostic factors prognostic factor Medtalk Any factor–eg, Pt age, family Hx, lifestyle, stage of presentation, that is weighed in determining a prognosis. See Prognosis.  in small malignant melanomas of choroid and ciliary body. Arch Ophthalmol. 1977;95:48-58.

[7.] Affeldt JC, Minckler DS, Azen SP, Yeh L. Prognosis in uveal melanoma with extraocular extension. Arch Ophthalmol. 1980;98:1975-1979.

[8.] McLean IW, Foster WD, Zimmerman LE. Uveal melanoma: location, size, cell type, and enucleation enucleation /enu·cle·a·tion/ (e-noo?kle-a´shun) removal of an organ or other mass intact from its supporting tissues, as of the eyeball from the orbit.
Enucleation
Surgical removal of the eyeball.
 as risk factors in metastasis. Hum Pathol. 1982;13:123-132.

[9.] Weinhaus RS, Seddon JM, Albert DM, Gragoudas ES, Robinson N. Prognostic factor study of survival after enucleation for juxtapapillary melanomas. Arch Ophthalmol. 1985;103:1673-1677.

[10.] Gamel JW, McCurdy JB, McLean IW. A comparison of prognostic covariates for uveal melanoma. Invest Ophthalmol Vis Sci. 1992;33:1919-1922.

[11.] Folberg R, Pe'er J, Gruman LM, et al. The morphologic mor·phol·o·gy  
n. pl. mor·phol·o·gies
1.
a. The branch of biology that deals with the form and structure of organisms without consideration of function.

b.
 characteristics of tumor blood vessels Blood vessels

Tubular channels for blood transport, of which there are three principal types: arteries, capillaries, and veins. Only the larger arteries and veins in the body bear distinct names.
 as a marker of tumor progression in primary human uveal melanoma: a matched case-control study case-control study,
n an investigation employing an epidemiologic approach in which previously existing incidents of a medical condition are used in lieu of gathering new information from a randomized population.
. Hum Pathol. 1992;23:1298-1305.

[12.] Coleman K, Baak JP, Van Diest P, Mullaney J, Farrell M, Fenton M. Prognostic factors following enucleation of 111 uveal melanomas. Br J Ophthalmol. 1993;77:688-692.

[13.] Folberg R, Rummelt V, Parys-Van Ginderdeuren R, et al. The prognostic value of tumor blood vessel morphology morphology

In biology, the study of the size, shape, and structure of organisms in relation to some principle or generalization. Whereas anatomy describes the structure of organisms, morphology explains the shapes and arrangement of parts of organisms in terms of such
 in primary uveal melanoma. Ophthalmology ophthalmology (ŏf'thălmŏl`əjē), branch of medicine specializing in the anatomy, function and diseases of the eye. Ophthalmologists specialize in the medical and surgical treatment of eye disorders, vision measurements for . 1993;100:1389-1398.

[14.] Folberg R, Rummelt V, Gruman LM, et al. Microcirculation microcirculation /mi·cro·cir·cu·la·tion/ (-sir?ku-la´shun) the flow of blood through the fine vessels (arterioles, capillaries, and venules).microcirculato´ry

mi·cro·cir·cu·la·tion
n.
 architecture of melanocytic nevi Nevus (plural, nevi)
The medical term for any anomaly of the skin that is present at birth, including moles and birthmarks.

Mentioned in: Malignant Melanoma, Moles


nevi

plural form of nevus.
 and malignant melanomas of the ciliary body and choroid: a comparative histopathologic and ultrastructural study. Ophthalmology. 1994; 101: 718-727.

[15.] Rummelt V, Folberg R, Woolson RF, Hwang T, Pe'er J. Relation between the microcirculation architecture and the aggressive behavior of ciliary body melanomas. Ophthalmology. 1995;102:844-851.

[16.] Folberg R, Verdick R, Weingeist TA, Montague PR. The gross examination of eyes removed for choroidal and ciliary body melanomas. Ophthalmology. 1986;93:1643-1647.

[17.] The Collaborative Ocular Melanoma Study Group. Design and Methods of a Clinical Trial for a Rare Condition: the Collaborative Ocular Melanoma Study, COMS COMS 3Com Corporation (stock symbol)
COMS Certified Orientation and Mobility Specialist
COMS Continuous Opacity Monitoring Systems
COMS City of Manchester Stadium (UK) 
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[19.] Fleming ID, Cooper JS, Henson DE, et al, eds. AJCC Manual for Staging of Cancer. 5th ed. Philadelphia, Pa: Lippincott Raven; 1997.

Bibliography

Albert DM. Principles of pathology. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Vol 4. Philadelphia, Pa: WB Saunders Co; 1994:2101-2126.

Albert DM, Dryja TP. The eye. In: Cotran RS, Kumar V, Robbins SL, eds. Pathologic Basis of Disease. 6th ed. Philadelphia, Pa: WB Saunders Co; 1998.

Yanoff MF, Fine BS. Ocular Pathology: A Text and Atlas. 3rd ed. Philadelphia, Pa: JB Lippincott Co; 1989:652-678.

Zimmerman LE. Malignant melanoma of the uveal tract. In: Spencer WH, ed. Ophthalmic Pathology: An Atlas and Textbook. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1986:2072-2139.

Accepted for publication May 10, 2001.

From the Department of Ophthalmology, University of Wisconsin Hospital, Madison, Wis (Dr Albert); and the Departments of Ophthalmology and Pathology, Scheie Eye Institute, University of Pennsylvania (body, education) University of Pennsylvania - The home of ENIAC and Machiavelli.

http://upenn.edu/.

Address: Philadelphia, PA, USA.
, Philadelphia, Pa (Dr Syed).

This protocol was developed by the Cancer Committee of the College of American Pathologists This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article.  and submitted for editorial review and publication. It represents the views of the Cancer Committee and is not the official policy of the College of American Pathologists.

Reprints: See Archives of Pathology & Laboratory Medicine Web site at www.cap.org.
COPYRIGHT 2001 College of American Pathologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2001 Gale, Cengage Learning. All rights reserved.

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Author:Albert, Daniel; Syed, Nasreen
Publication:Archives of Pathology & Laboratory Medicine
Geographic Code:1USA
Date:Sep 1, 2001
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